Pediatric contrast-enhanced ultrasound: optimization of techniques and dosing
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CONTRAST-ENHANCED ULTRASOUND (CEUS) IN CHILDREN
Pediatric contrast-enhanced ultrasound: optimization of techniques and dosing Misun Hwang 1,2 & Susan J. Back 1,2 & Ryne A. Didier 1,2 & Norbert Lorenz 3 & Trudy A. Morgan 1 & Laura Poznick 1 & Ludwig Steffgen 4 & Anush Sridharan 1 Received: 24 June 2020 / Revised: 8 July 2020 / Accepted: 10 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract When performing contrast-enhanced ultrasound (CEUS), ultrasound (US) scanner settings, examination technique, and contrast agent dose and administration must be optimized to ensure that high-quality, diagnostic and reproducible images are acquired for qualitative and quantitative interpretations. When carrying out CEUS in children, examination settings should be tailored to their body size and specific indications, similar to B-mode US. This review article details the basic background knowledge that is needed to perform CEUS optimally in children, including considerations related to US scanner settings and US contrast agent dose selection and administration techniques. Keywords Children . Contrast-enhanced ultrasound . Dose . Technique . Ultrasound . Ultrasound contrast agent
Introduction Contrast-enhanced ultrasound (CEUS) is an advanced imaging modality that is performed with US and requires the administration of US contrast agents (UCAs). UCAs act as strong reflectors of US waves, backscattering a bright echo signal that is detected by using contrast-specific US software [1–3]. The most commonly used commercial UCAs consist of microbubbles of inert gases stabilized by protein or lipid shells. While the microbubbles of the different UCAs vary in terms of mean bubble size and concentration, they are all smaller than red blood cells. The microbubbles expand and contract when interacting with the US beam, returning nonlinear signals to the transducer [2, 3]. Because they are
* Misun Hwang [email protected] 1
Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
2
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
3
Children’s Hospital, Dresden Municipal Hospital, Teaching-Hospital of Technical University, Dresden, Germany
4
Trainings-Zentrum Ultraschall-Diagnostik LS GmbH, Mainleus, Germany
sensitive to the acoustic pressure of a US wave, administration techniques and scanning parameters need to be optimized to maximize the lifespan of the contrast agent for diagnostic imaging and interventional procedures. UCAs that are administered intravenously remain confined within the blood pool. CEUS detects, in real time, the circulating microbubbles as strong echoes moving within the vessels, thus providing micro- and macro-vascular information that is used to assess the vascular perfusion of a lesion or organ [3, 4]. UCAs can also be administered into body cavities for diagnostic imaging and interventional procedures. The UCA is delivered directly through tubes or catheters in a similar manner to normal s
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